The Doctor With a Diagnosis System

CHAPTER 5: Clinical Death

The continuous, shrill wail of the flatlining heart monitor drilled directly into my skull. It was a sound I heard in my nightmares, but right now, it was tearing through the quiet of Observation Room 3.

Mr. Han’s back remained arched off the thin mattress, rigid as a wooden board. The heavy, greasy sheen of sweat on his face caught the harsh fluorescent light above the bed. His eyes were rolled entirely back. The man was dead. His heart had completely stopped pumping blood to his brain.

"What did you do?!"

The scream came from right behind me. Nurse Yu Mi-Sun stood in the doorway, a plastic tray of IV medications dropping from her hands. Tiny glass vials of pantoprazole shattered against the linoleum, splashing clear liquid over my sneakers.

She looked from the flatline on the monitor to the massive red crash cart my hands were gripping. Then, she looked at my face, recognizing the dark circles under my eyes and the faded gray hoodie.

"Intern Ryeong?" Mi-Sun gasped, her voice trembling. "You're supposed to be off the floor! Dr. Kang suspended you! Get away from the patient!"

I didn't move. My eyes were locked on the glowing blue screen hovering over Mr. Han’s chest.

[Time Remaining: 00:00:00]

[Patient Status: Clinical Death]

[Cause: Aortic Rupture -> Hemopericardium -> Cardiac Tamponade]

My medical instincts, drilled into me over years of grueling study, screamed at me to start chest compressions. The guy was flatlining. You do CPR. You push epinephrine. That was the protocol. I let go of the crash cart handle and took a step toward the bed, raising my hands to interlock my fingers over his sternum.

Instantly, the blue screen flashed a blinding, violent crimson, throwing a red tint over the entire room.

[CRITICAL WARNING: DO NOT COMPRESS CHEST.]

[The ascending aorta has ruptured into the pericardial sac.]

[Performing CPR will actively squeeze more blood out of the torn artery, accelerating internal hemorrhage. It will guarantee permanent death.]

[Immediate Action Required: Relieve pressure around the heart.]

I froze, my hands hovering an inch above his skin.

The System was right. God, it was right. Mr. Han’s aorta—the main pipe carrying blood out of his heart—had ripped open. The blood wasn't flowing into his body; it was pouring into the tough, fibrous sac surrounding his heart. The sac was filling up like a water balloon. The sheer pressure of the trapped blood was literally crushing his heart from the outside in, preventing it from beating.

If I pushed down on his chest, I would just pop the balloon and kill him instantly.

"Intern Ryeong, step away right now or I am calling security!" Mi-Sun yelled, reaching for the emergency phone mounted on the wall.

"Call a code blue!" I roared, my voice tearing at my dry throat. "And page CT Surgery! Tell them we have a ruptured ascending aortic dissection!"

"Dr. Si Jae said it was severe reflux—"

"Si Jae is a lazy idiot who just killed this man!" I snapped, ripping open the top drawer of the crash cart. "Page surgery now, or he’s dead in three minutes!"

I didn't wait to see if she obeyed. I heard the frantic beeping of the wall phone, but I tuned it out. I dug through the plastic wrappers in the cart, tossing rolls of tape and gauze aside until I found it. A massive, six-inch spinal needle and a fifty-cc syringe.

My hands were shaking. The adrenaline from the ER was completely gone, replaced by a cold, sickening panic. I wasn't wearing sterile gloves. I wasn't wearing a gown. I was a suspended intern in street clothes about to stab a massive needle directly into a patient’s chest cavity. If I missed, I would puncture a lung. Or worse, I would stab the heart muscle itself and finish the job the dissection started.

[Target Area Highlighted: Subxiphoid Approach]

A glowing yellow ring appeared on Mr. Han's skin, just below the center of his ribcage, slightly to the left.

I ripped the plastic packaging off the needle with my teeth and attached it to the syringe. I pressed two fingers just below his sternum, feeling for the bony landmark. His skin was already turning a horrifying, mottled shade of blue-gray. The clock in my head was ticking. Brain damage begins at the three-minute mark of oxygen deprivation. We were already at sixty seconds.

I angled the long needle upward, aiming precisely toward his left shoulder, right through the center of the glowing yellow ring.

I pushed.

The resistance of the skin and muscle was tough. I had to force it, gritting my teeth as the thick metal slid deep into his chest. Two inches. Three inches.

Pop.

I felt the distinct, subtle give of the needle piercing the tough pericardial sac.

I held my breath and pulled back on the plastic plunger of the syringe. Instantly, thick, dark red blood shot up the barrel. It was terrifyingly dark—deoxygenated blood that had been pooling around his heart.

"You're draining it," Mi-Sun whispered from behind me, the phone hanging loosely from its cord.

I pulled the plunger back until the fifty-cc syringe was completely full. I unscrewed it, dumped the dark blood violently onto the floor—splattering my shoes—reattached the barrel, and pulled again. Another fifty cc's of trapped blood filled the plastic tube.

The pressure inside his chest was dropping. I prayed it was enough.

The flatline wail of the monitor suddenly cut out.

Beep.

A long, agonizing second of silence passed.

Beep... Beep...

It was incredibly weak, sluggish, and irregular, but the green line on the screen spiked. The heart, freed from the crushing pressure of the trapped blood, finally managed to squeeze out a pathetic, desperate pump.

I let out a shaky breath, my arms heavy as lead. I kept the needle perfectly still, holding it in place so the sac wouldn't refill immediately.

The wooden door to the observation room slammed open so hard it rebounded off the wall.